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Friday, November 20, 2015

Investigation into Infections Leads to Dead End

It’s not often you read an article where an investigation
has been halted because the source of an infection cannot be found, but that
seems to be the case in Toronto. For an
unknown reason there has been a 78% increase in the number of Torontonians
testing positive for Mycobacterium avium – to put that
number into perspective that equates to 66 new cases each month between June
2014 and June 2015!

While there is cause for concern, there is no need
for people to panic. Most people who
become infected by M. avium have
underlying conditions such as age, HIV-positive and those with pre-existing
lung problems. The unfortunate truth is
that most people who become ill end up with lung damage and develop reoccurring
lung infections, as the main symptoms are similar in nature to Tuberculosis. M.
avium is ubiquitous in nature and has been isolated from fresh and salt
water worldwide. The common environmental sources include; aerosolized water, piped
hot water systems (including household and hospital water supplies), house dust,
soil, birds, farm animals and cigarette components (e.g., tobacco, filters,
paper).

Transmission is generally thought to be due to
inhalation of environmentally derived airborne organisms rather than person to
person, however, oral ingestion may also be a route of infection but is
generally considered more likely in the immunocompromised host. Because
it is primarily transmitted by inhaling droplets of water, municipal water
supplies are often the original source – but it’s important to understand that
drinking water is not how you’re going to get it. Total eradication of the bacteria from
municipal water supplies is virtually impossible as the bacterium tends to grow
in biofilms that are known to line the large water pipes used in municipal
water distribution systems.

While this current situation is associated with
humans, M. avium can also cause
infections in pigs, domestic and wild birds, cattle, sheep, goats, cats and
dogs. However, the mechanism of
transmission and type of infection can vary greatly. Domestic and wild birds become infected by
ingesting contaminating food and/or soil.
Similarly, other animals can be infected by ingesting contaminated soil
or infected poultry. The long and the
short is that due to the ubiquitous nature of this bacterium it’s impossible to
avoid being exposed to the bacteria. The
best way to prevent developing the disease is to keep your immune system
strong.

As for Toronto, numerous experts
want to see the spike in cases investigated further. While there does not seem to be a specific
area of the city impacted more than others or clustering of cases that could be
associated with environmental exposure, it is obvious that by the sudden spike
in cases in June of last year that there was a tipping point when something
changed and it certainly would be nice to get to the bottom of it!